Jo Franks, a breast surgeon, gives women the space they need to talk about breast cancer issues and decisions.
When diagnosed with breast cancer, it’s crucial that women are given the information they need to select the treatment option that’s right for them. Too often, says leading breast surgeon Joanna Franks, they feel pressured, afraid and ill-informed.
Jo Franks is a breast and oncoplastic surgeon and lead consultant at UCLH (University College London Hospital).
Like many people who become doctors, Jo knew from the age of about two that she wanted to go into medicine, and when the time came to choose her vocation, she chose to become a surgeon: “We treat disease, whereas medics just control it,” she explains. “I decided to specialise in breast surgery because I felt it was a field where I could really make a difference.”
Asked what she particularly loves about her work, Jo explains it’s the chance to connect with patients. “I know I am taking them on a very difficult journey but I want to leave them feeling positive at the other end.” She believes it’s vital for women to feel they have a connection with their medical team: “Everyone is entitled to a second opinion on the NHS—not many people know that. So do be sure you feel comfortable with your surgeon and the entire team—after all, you’re going to be entering into a therapeutic alliance with them.”
Lumpectomy v's. Mastectomy? Take Time to Make the Decision
When a woman is diagnosed with breast cancer, it is a huge shock, and naturally it feels like an emergency: She wants to get rid of the cancer as soon as possible and improve her chances of survival. But, says Jo, in most cases the emphasis should be firmly on achieving the right outcome from a woman’s treatment, which requires that she take some time to understand her options.
“Being told you have breast cancer doesn’t mean you must have an emergency operation,” she explains. “For most people there is time to get information and make a decision. We seek information on much more trivial things—think about buying a car or a house, or changing insurance provider—yet for something as important as this we often just do as we’re told, and sometimes regret it later. A lot of these decisions are absolutely irreversible. It’s really important that women know this, and I believe it’s up to us to empower each other as women.”
Long-term Breast Surgery Outcomes
Expanding on her message about patient choice and how women need to be as well informed as possible, Jo continues: “Let’s think about mastectomy. For some women
there is no choice but to have one, but nowadays there are lots of options: a straightforward mastectomy, mastectomy with immediate reconstruction
, or with delayed reconstruction. Most women don’t know about this and they need time to understand the differences and think about what they want. Women worry that discussing aesthetics is about vanity; this is not the case— it is part of the long-term outcomes.
“There’s a lot of emphasis these days on survivorship, and the right decision at the beginning of your treatment will ensure you feel much better at the end— and for the rest of your life.”
How are medical teams helping women become better informed? “At my practice, if you are given a breast cancer diagnosis
and treatment options you are never asked to make a decision at that point,” says Jo. “You have an appointment with a clinical nurse specialist, look at photographs, feel implants and silicone breast forms
, ask questions about the procedures, and then— when you are ready— you give your consent at a subsequent meeting with me.”
Some women also have longer to think about their options because their treatment starts not with surgery but with pre-operative chemotherapy or drugs to shrink their tumor, which could make it possible for them to have breast-conserving surgery rather than mastectomy.
Jo asks her patients to bear in mind that no two cancer journeys are the same. “Breast cancer is two words but it is hundreds of different types of cancer. These days we are going down the route of personalised medicine—finding out about the patient’s breast cancer and giving the right drugs and order of treatment for each individual, for better outcomes.”
Girl Talk: A Pre-surgery Support Group for Breast Cancer
“At our regional plastics unit they run a ‘Show and Tell’ session where women come together and talk about their experience of breast cancer, show their reconstructions and allow others to feel them. Women who are about to have treatment get so much out of these groups, and it shows how confident patients can feel after surgery,” says Jo. “It’s important that there are no surgeons in the group though—this isn’t about what we think about breast surgery, it’s what the women themselves think, and they can only speak openly when we are not there.
“I’d love to see more groups like this taking place. We women are very good at supporting each other —we just need the right environment to do it in.” Local breast cancer support groups and mastectomy boutiques might consider partnering with breast care doctors, who could refer patients to these “pre-surgery” information sessions. It’s just this kind of ‘girl talk’ that really helps patients feel educated, informed, and less alone.
Facing Breast Cancer Prepared: It Helps to Know what’s Available
“When I do a mastectomy without reconstruction for whatever reason, I tell women there is specially designed mastectomy lingerie, pocketed swimwear and breast prostheses that mean they can do everything they did before, and no-one will ever know. Partial breast shapers and the right lingerie can also help with asymmetry in the case of reconstruction.
“The thing is, if you haven’t had to face this before, you would have no idea what’s out there. Knowledge is power.”